Cost effectiveness of teriparatide and PTH(1-84) in the treatment of postmenopausal osteoporosis

Abstract

Objectives:

The purpose was to assess the cost effectiveness from a societal perspective of the recombinant human parathyroid hormones: PTH(1-34) (teriparatide) and PTH(1-84) for patients with osteoporosis with similar characteristics to patients treated in normal clinical practice in Sweden.

Methods:

A Markov model of osteoporosis in postmenopausal women was developed using 6-month cycles and a lifetime horizon. The model was populated with patients similar to the Swedish cohort of the European Forsteo Observational Study (postmenopausal women; mean age: 70 years, total hip T-score: −2.7 and 3.3 previous fractures). The cost effectiveness of both teriparatide and PTH(1-84) was estimated compared to no treatment and each other. Relative effectiveness assumptions were based on efficacy estimates from two phase III clinical trials.

Results:

The cost per QALY gained of teriparatide vs. no treatment was estimated at €43,473 and PTH(1-84) was estimated at €104,396. Teriparatide was indicated to be less costly and associated with more life-years and QALYs than PTH(1-84). When assuming no treatment effect on hip fractures the cost per QALY gained was €88,379. In the sensitivity analysis the cost effectiveness did not alter substantially with changes in the majority of the model parameters except for the residual effect of the treatment after stopping therapy.

Conclusions:

Based on the efficacy estimates from pivotal clinical trials and characteristics of patients treated in clinical practice in Sweden, teriparatide seems to be a more cost-effective option than PTH(1-84) when compared to no treatment. The relative efficacy between the two PTH compounds was based on an indirect comparison from two separate clinical trials which has to be considered when interpreting the results.

Key words::

• cost effectiveness
• osteoporosis
• parathyroid hormone
• teriparatide

Transparency

Declaration of funding

This study was supported by Lilly Europe.

Declaration of financial/other relationships

F.B. and O.S. have disclosed that they are have undertaken health economic analyses in the field of osteoporosis for several agencies and pharmaceutical companies, including Lilly. F.M. has disclosed that he is an employee of Lilly, and A.K. has disclosed that he is a former employee of Lilly. Ö.L. has disclosed that he has been a scientific advisor for Lilly.

Acknowledgements

The authors would like to thank Annabel Barrett, Lilly Europe for her help in preparing this manuscript.

Notes

*Forsteo, Eli Lilly AB, Sweden.

†Preotact, Nycomed AB, Sweden.